Homelessness and Health: With special focus on the common clinic problem of substance misuse and harm reduction applied to homeless patients

Background: Morbidity and mortality rates are significantly higher among homeless people than the average population. Reasons for this are: widespread substance misuse, lack of awareness of rights to healthcare and poor access to healthcare. This is a problem that does not receive the attention it requires to change things.
The purpose of this article is to investigate substance misuse and harm reduction philosophy as applied to the homeless population and to discuss the controversy around this subject. I want to focus on services provided to intravenous drug users, primarily: needle exchange and provision of clean works to prevent the spread of blood-borne viruses and heroin maintenance programs.

Methods: This paper is based on a review of existing literature and a review of policies regarding homelessness and health. I spent two weeks on service learning visits: visiting various day centres, homeless hostels, a soup kitchen and homeless clinics. The most valuable of these to me were the afternoon spent with Dr Sutton, at the homeless clinic in St Helens and the meeting with Julia Cottier at Aqua House, Chester.

I read Nat Wright’s Homelessness: A Primary Care Response, and Drug Misuse and Dependence, UK guidelines on clinical management; as suggested by Dr O’Neill. I also collected information from drugs misuse websites, websites about homelessness, medical journals, NTA publications and guidelines, service users and drugs workers.